Provider Demographics
NPI:1750252854
Name:JEGEDE, JOHN OLORUNTOBI (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:OLORUNTOBI
Last Name:JEGEDE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 BAYVIEW BLVD APT 502
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4459
Mailing Address - Country:US
Mailing Address - Phone:443-794-3193
Mailing Address - Fax:
Practice Address - Street 1:6838 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-8301
Practice Address - Country:US
Practice Address - Phone:410-825-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty